Endocrine Abstracts

Studies have demonstrated an increased mortality in patients with acromegaly. The major cause of premature death was cardiovascular disease. Cardiovascular mortality was increased in patients with high levels of growth hormone (GH). Somatostatin analogues, such as octreotide, are effective in relieving the symptoms of acromegaly and supressing GH hypersecretion. Long acting preparations, such as Sandostatin-LAR, offer theoretical advantages over SC preparations, such as improving metabolic control and patient compliance.

Following ethical committee approval, we therefore studied the effect of switching 9 patients (8M,1F) with acromegaly from SC octreotide to sandostatin-LAR, on GH secretion, total body water (by bioelectrical impedance) and left ventricular mass (by cardiac magnetic resonance imaging).

We found a significant fall in 08.00 GH levels, mean of GH day curve (08.00-16.00), IGF-1 levels and extracellular water from baseline to 6 months post switch [9.5 mU/L vs 3.9 mU/L, 4.4 mU/L vs 3.5 mU/L, 58 nmol/L vs 40.5 nmol/L and 23.9 Kg vs 22.8 Kg (all P values < 0.05]. Left ventricular (LV)mass fell by 20.1 grams (P<0.05) over the 2 months prior to the switch from SC octreotide to Sandostatin-LAR, and this was maintained following 6 months on Sandostatin-LAR.

We conclude that switching from SC octreotide to Sandostatin-LAR, improves metabolic control, lowers extracellular water and maintains reduction in LV mass.